Evaluation of several screening approaches for detection of cervical lesions in rural Shandong, China

• Published in: Asian Pacific journal of cancer prevention : APJCP Vol. 16; no. 5; p. 1907
• Main Authors: Zong, Li-Ju, Zhang, You-Zhong, Yang, Xing-Sheng, Jiang, Jie, Cui, Bao-Xia, Qiao, Yun-Bo, Li, Li, Jiang, Kan, Zhang, Wen-Jing, Kong, Bei-Hua, Shen, Keng
• Format: Journal Article
• Language: English
• Published: Thailand 2015
• Subjects: Acetic Acid; Adult; Alphapapillomavirus - genetics; Cervical Intraepithelial Neoplasia - diagnosis; China - epidemiology; DNA, Viral - isolation & purification; Early Detection of Cancer - methods; Female; Human Papillomavirus DNA Tests - methods; Humans; Iodides; Mass Screening - methods; Middle Aged; Papanicolaou Test - methods; Papillomavirus Infections - epidemiology; Rural Health; Rural Population; Uterine Cervical Neoplasms - diagnosis; Vaginal Smears - methods; China
• ISSN: 2476-762X

The study was designed to: (1) investigate the prevalence of high-risk human papillomavirus (HR- HPV) infection and cervical neoplasia; and (2) evaluate clinical performance of visual inspection with acetic acid/ Lugol's iodine (VIA /VILI), Pap smear, high-risk human papillomavirus (HR-HPV) DNA test for detecting cervical intraepithelial neoplasia grade 2 or worse (CIN2+) and (3) explore appropriate screening approach in rural areas of Shandong Province. A total of 3,763 eligible women from Yiyuan County in Yimeng mountainous areas of rural Shandong, China, were enrolled and underwent Pap smear, HR-HPV DNA testing by Hybrid Capture 2 (HC2), and VIA /VILI tests. Women positive in any test were referred to colposcopy and biopsy as indicated. The prevalence of HR-HPV infection among all enrolled women was 11.1% and that in healthy women was 9.9%. In total 33 cases of CIN1, 16 cases of CIN2, 6 cases of CIN3 but none of cervical cancer were detected and the crude prevalence of CIN2+ was 0.58%. For detecting CIN2+, the sensitivity of HR-HPV DNA testing, VIA/VILI, Pap smear was 90.9%, 77.3%, 81.8%, respectively. Pap smear had the best specificity of 98.2%, followed by HR-HPV DNA testing with specificity of 89.4%, VIA/VILI had the lowest specificity of 81.2%. Colposcopy referral rate of HR-HPV DNA testing, VIA/VILI, Pap smear was 11.1%, 18.5%, 2.3%, respectively. Our results suggest that HR-HPV DNA testing alone might be appropriate for primary cervical cancer screening in rural low-resource areas of Shandong Province, China.